Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Comparison of hazard of death following surgery for colon versus rectal cancer(Sri Lanka Medical Association, 2016) Ediriweera, E.P.D.S.; Kumarage, S.; Deen, K.I.INTRODUCTION: Prognosis in cancer is usually assessed by use of Kaplan-Meier survival function estimate curves, which reflect survival, or the proportion of patients that will remain alive after a particular event at a given time. By contrast, hazard function represents the proportion expected to be deceased among those surviving at a given time after an event. OBJECTIVES: To evaluate survival and hazard of death, in patients with colon cancer (CC) and rectal cancer (RC), as indices of prognosis. METHODS: Colon and rectal cancer patients who underwent surgical resection with curative intent from 1996 to 2011 were studied. The hazard of death and survival patterns were assessed with Weibull Hazard models and Kaplan- Meier survival function estimate curves. RESULTS: There were 119 CC and 250 RC patients included in the study. Median (Inter-quartile range: IQR) age of both groups was 58 (49 - 66.5) years. The median (IQR) followup time was 30 (12 - 72) months for CC and 30 (13 - 70) months for RC. Both groups were similar in comparison with regard to age (p=0.96), gender (p=0.56), tumour stage (p=0.33), vascular invasion (p=0.69), lymphatic invasion (p=0.33), perineural invasion (p=0.94), degree of tumour differentiation (p=0.38) and preoperative carcinoembryonic antigen levels (p=0.77). CC showed better overall survival compared to RC (p=0.03) with a 5-year survival rate of 72% versus 60% respectively. After curative resection, CC showed a 6% decrease in hazard of death with time compared with RC which showed a 1% increase in the hazard of death with time. CONCLUSIONS: Among patients who underwent resectional surgery, CC had a better prognosis than RC.Item Colorectal cancer in the young, many questions, few answers(Baishideng Publishing Group, 2016) Deen, K.I.; Silva, H.; Deen, R.; Chandrasinghe, P.C.At a time where the incidence of colorectal cancer, a disease predominantly of developed nations, is showing a decline in those 50 years of age and older, data from the West is showing a rising incidence of this cancer in young individuals. Central to this has been the 75% increase in rectal cancer incidence in the last four decades. Furthermore, predictive data based on mathematical modelling indicates a 124 percent rise in the incidence of rectal cancer by the year 2030 - a statistic that calls for collective global thought and action. While predominance of colorectal cancer (CRC) is likely to be in that part of the large bowel distal to the splenic flexure, which makes flexible sigmoidoscopic examination an ideal screening tool, the cost and benefit of mass screening in young people remain unknown. In countries where the incidence of young CRC is as high as 35% to 50%, the available data do not seem to indicate that the disease in young people is one of high red meat consuming nations only. Improvement in our understanding of genetic pathways in the aetiology of CRC, chiefly of the MSI, CIN and CIMP pathway, supports the notion that up to 30% of CRC is genetic, and may reflect a familial trait or environmentally induced changes. However, a number of other germline and somatic mutations, some of which remain unidentified, may play a role in the genesis of this cancer and stand in the way of a clear understanding of CRC in the young. Clinically, a proportion of young persons with CRC die early after curative surgery, presumably from aggressive tumour biology, compared with the majority in whom survival after operation will remain unchanged for five years or greater. The challenge in the future will be to determine, by genetic fingerprinting or otherwise, those at risk of developing CRC and the determinants of survival in those who develop CRC. Ultimately, prevention and early detection, just like for those over 50 years with CRC, will determine the outcome of CRC in young persons. At present, aside from those with an established familial tendency, there is no consensus on screening young persons who may be at risk. However, increasing awareness of this cancer in the young and the established benefit of prevention in older persons, must be a message that should be communicated with medical students, primary health care personnel and first contact doctors. The latter constitutes a formidable challenge.Item The hazard of death decreases after surgical treatment for colon cancer but not after surgical treatment for rectal cancer(Sri lanka Medical Association, 2015) Ediriweera, E.P.D.S.; Deen, K.I.INTRODUCTION AND OBJECTIVES: Prognosis in cancer is usually assessed by survival patterns. In this study we evaluated both survival patterns and hazard of death as indices of prognosis to compare colon and rectal cancer. METHOD: Colon and rectal cancer patients who underwent surgical resection from 1996 to 2011 were studied using Kaplan-Meier survival function estimate curves and Weibull Hazard models. RESULTS; Of 369 patients {119 (32%) colon cancer and 250 (68%) rectal cancer), overall 5-year survival rate for colon and rectal cancer was 72% and 60% respectively (P = 0.03). For colon cancer, survival indices diminished when tumor disseminated outside the region of the colon (Stage IV), while in rectal cancer survival indices reduced as cancer progressed from stage I to I! and beyond. As expected, stage for stage survival for colon and rectal cancer were similar for stages 1 and IV (Stage 1, 5 year survival colon vs. rectum; 77% vs. 82% and stage IV; 25% vs. 22%). However, survival in intermediate stages (stage II and stage III) was better for colon cancer compared to rectal cancer (Stage M, 5 year survival colon vs. rectum; 81% vs. 62% and stage III; 70% vs. 55%). After curative resection, colon cancer showed a 6% decrease in hazard of death with time compared with rectal cancer which showed a 1% increase in the hazard of death with time. CONCLUSION: Overall, underwent curative resection, colon cancer had better survival indices compared with rectal cancer.